Abstract

The COVID-19 pandemic accelerated the global adoption of electronic health (e-health) tools for digital mental health services (DMHS) in South African higher education institutions (SA HEIs). However, the long-term sustainability of these innovations remains uncertain. This study employs an integrated Technology-Organisation-Environment (TOE) and Technology Acceptance Model (TAM) framework to investigate determinants of the sustainable adoption of e-health tools. A cross-sectional survey of 348 staff at a selected SA HEI was analysed using descriptive statistics and exploratory factor analysis. Three critical factors emerged: (1) University capacity to deliver DMHS, emphasising the significance of top management support, financial resources, and information and communications technology expertise; (2) Perceived benefits and importance of e-health tools, highlighting user perceptions of usefulness, ease of use, and behavioural intention; and (3) External support to enhance university capacity, including government policies, competitive pressures, and institutional partnerships. The study advances theory by synthesising TOE and TAM in a resource-constrained context, revealing how institutional readiness and user perceptions jointly influence the sustainable adoption of e-health tools for DMHS. Practical implications highlight the need for targeted investments in digital infrastructure, capacity-building, and policy alignment to strengthen DMHS sustainability. The study results are consistent with Sustainable Development Goal 3 (SDG 3), offering a roadmap for SA HEIs to leverage e-health tools for mental health resilience post-pandemic.